Hospitals are ill-equipped to treat behavioral health, ECRI finds

Many hospitals aren't equipped to treat patients with behavioral health needs, but they could do better if they develop a clear vision for caring for those patients, according to a new report released Wednesday.

The not-for-profit ECRI Institute Patient Safety Organization found that about half of the 2,400 behavioral health events at hospitals they studied involved patient violence against others, while 81 incidents involved temporary or minor patient harm.

"The acute-care units aren't equipped to treat the behavioral health symptoms patients are bringing with them," said Nancy Napolitano, patient safety analyst at the ECRI Institute. "There are few psychiatrists and there are fewer psychiatric beds available. A lot of hospitals have closed their psychiatric units, so a hospital is a difficult place for behavioral health patients. We have a definite shortage of resources, especially in more rural areas."

The lack of appropriate inpatient mental health services in the U.S. dates back to the 1950s with a movement to deinstitutionalize people with behavioral health needs and integrate them into the community. Since then, the prevalence of those with mental health disorders has grown and the number of psychiatrists hasn't met the demand so hospitals—especially in rural areas—struggle to offer adequate services, Napolitano said.

About 42% of inpatient stays for a physical health condition also involve a secondary mental or substance abuse disorder, according to a recent study from the Agency for Healthcare Research and Quality.

But the lack of resources shouldn't prevent hospitals from giving patients appropriate care. ECRI encouraged hospital leaders to create strategic teams that include frontline staff, evaluate their needs and advocate for change at the regional, state or federal level.

Napolitano said it's critical that hospital administrators lead and support the improvements.

"If you don't have the leadership support for any kind of program or implementation it isn't going to get very far. You have to have the buy-in from leadership to recognize this is a problem," she said.

Napolitano added that many of the institute's recommendations can be accomplished even if a hospital has a low budget. For instance, the report offers 10 ways hospital staff can deescalate tense or potentially violent situations with patients. "That kind of training can happen in any environment," she said.

Regarding the recommendation for hospitals to advocate for broader change, ECRI said hospitals and health systems should consider partnering with government agencies, legislators and payers to advocate for improvements like changes to insurance authorizations and telehealth requirements.

"Many of the challenges that acute care organizations face in meeting patients' behavioral health needs have roots in the ways society views and provides treatment for behavioral health," ECRI said in the report's executive brief.